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WO2007113623A1 - Procede et dispositif pour le traitement au laser local d'une surface irreguliere - Google Patents

Procede et dispositif pour le traitement au laser local d'une surface irreguliere Download PDF

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Publication number
WO2007113623A1
WO2007113623A1 PCT/IB2006/051047 IB2006051047W WO2007113623A1 WO 2007113623 A1 WO2007113623 A1 WO 2007113623A1 IB 2006051047 W IB2006051047 W IB 2006051047W WO 2007113623 A1 WO2007113623 A1 WO 2007113623A1
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WO
WIPO (PCT)
Prior art keywords
treatment
area
pilot light
image
points
Prior art date
Application number
PCT/IB2006/051047
Other languages
English (en)
Inventor
Stefano Bizzi
Original Assignee
Advanced Computer Systems A.C.S. S.P.A.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Advanced Computer Systems A.C.S. S.P.A. filed Critical Advanced Computer Systems A.C.S. S.P.A.
Priority to PCT/IB2006/051047 priority Critical patent/WO2007113623A1/fr
Publication of WO2007113623A1 publication Critical patent/WO2007113623A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/10—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions
    • A61B3/113—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions for determining or recording eye movement
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00821—Methods or devices for eye surgery using laser for coagulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00844—Feedback systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00863—Retina
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00872—Cornea

Definitions

  • the current invention refers to a method for local laser treatment of an irregular surface, not metric and subjected to accidental movements.
  • ⁇ not metric surface' means a surface whose 2D image cannot be described in a fixed reference system, by means of unambiguous space measures .
  • accuracy movements stands for movements whose frequency, direction, excursion and speed cannot be predicted a priori.
  • a typical example is a human tissue which needs a surgical intervention.
  • the first technique consists in the target area immobilization - as long as it is possible - in order to construct a related fixed reference system. This allows to define the minimum surgical intervention area size, using spatial coordinates. Afterwards, the intervention takes place when the intervention area is on the supposed correct position. This requires to predict and compute the surface random movements, even if limited. It is clear that this methodology is extremely complex and requires the accidental movements control . Moreover, the operation precision is strictly connected to the ability to predict the overlapping between the real target and the area on which the operation has been planned. Such precision turns out to be not satisfactory in most of the practical applications.
  • the second methodology consists in the creation of an observation field, for example by using a slit lamp, which has limited dimensions but can visualize the whole area to be operated.
  • the resulting image can be highly enlarged.
  • the operation starts therefore by using a pilot light pointing the surface and by taking advantage of manual ability.
  • the operator constantly observes the pilot light and performs the surgery when the light correctly points the target.
  • This technique is obviously limited by the ability of the operator.
  • the surgeon observers the highly enlarged scene and compares it to the image acquired during the diagnostic phase, which reveal the pathology position.
  • By moving the pilot light he tries to correctly overlap it to the target. Once he decides the pilot light and the target point are aligned, he activates the laser beam.
  • Raster image we mean the result of the original image partition in regular elements (matrix or grill) .
  • Each Raster Image element is associated to the physical parameter absolute value (temperature, reflectivity, etc) as measured by the acquisition sensor.
  • a device for the local treatment of an irregular surface not metric and subject to accidental movement, that comprises: a surface lighting system; a system for real time acquisition of a digital RASTER image of such surface; • an image management system that allows the identification of such defined surface areas, each of them unambiguously defined by a set of pixels,- a memory, to store data corresponding to the aforesaid areas; • a pointing system, supporting a system for punctual treatment - in order to realize a local treatment - projecting a pilot light on such surface; ⁇ a computational system for the shifting vector between the pilot light and the punctual surface area in order to compute the iterative pilot light displacement, the displacement computation defining the light optical path until the overlapping between the pilot light and the above mentioned area is obtained, so that, when the overlapping is obtained, the punctual treatment is performed.
  • the method and the device allow to realize an effective pointing for the localized treatment, which is not depending on the operator manual abilities or observing capabilities.
  • a powerful lighting system should be necessary in case of human intervention in order to ensure the correct visualisation of the area to be treated.
  • the lighting system can be realized with a brightness level less than the one demanded in the human vision.
  • the local treatment that takes more advantages from the current method is the laser treatment, especially for surgery intervention on living tissues where the power laser is employed for ablation and photocoagulation.
  • figure 1 schematically shows the treatment device following an example of the invention deployment
  • figure 2 shows an enlargement of an ocular surface that can constitute a typical method application, according to the invention.
  • the device for the local treatment is showed with number
  • the laser emission device shown in figure 2, works projecting a pilot light which is able to represent on the image a point pointed by the treatment system, on the ocular surface to be treated, indicated with S.
  • the latter is filmed by a system of digital images acquisition, 3, operating in real time, which determines a flow of images (streaming), that sends such images, 10, to a computer, 4, equipped with processor and memory.
  • the images acquisition system, 3, is constituted by a digital camera with a specific spatial and radiometric resolution, an acquisition frequency, is coupled with the surface, S, lighting system.
  • This system which is conventional and not represented, projects a ring of light subjected to the recording of the images, and constitutes an area of fixed visualization, F.
  • the acquisition system operates in real time on the digital image, 10, of the surface S, splitting in a variety of pixels, according to the resolution, and associating to each pixel a reference value, according to a modality called RASTER.
  • the acquired image is split in a set of very small cells, organized in regular matrix, called pixel, having an homogenous content not furtherly separable .
  • the elaboration system controls the laser device 2 both for pointing and activation.
  • the processor 4 is controlled by a user interface 5, typically a PC.
  • the operator can select any parameter of the system and control the correct working.
  • the interface integrates an image management system that allows the areas identification of the surface S, unambiguously defined with a set of pixels of such areas. It is possible to store data corresponding to these areas and to record the ongoing procedure .
  • the computer integrates a computational system for a shifting vector between the pilot light and a point on the surface, for the pilot light iterative displacement, which will coincide with the optical path of the pilot light, as far as the overlapping with such area and the maintenance of the position has been reached.
  • the computer which is constantly under the doctor control, will switch on the laser device, and the punctual treatment of the preselected area will be carried out.
  • Images Acquisition The images acquisition system 3 captures in real time the images of the ocular surface which has to be treated. The surface is not metric and subject to accidental movements during acquisition. Each images is split in a variety of pixels, according to a resolution, and a reference value is associated to every pixel.
  • One of digitized images, filmed by the systems 3, is used to set up the subsequent phases .
  • the image acquisition is performed using a surface appropriate lighting system, which defines a visualization area that appears on a monitor and allows to visualize the area subject to the operation and to evaluate the treatment trend.
  • Target area definition
  • the ocular surface to be treated suffers a pathology that can be cured by means of photocoagulation induced by laser device, or by a punctual treatment that acts on an elementary area whose dimensions are set up in the device itself.
  • the digital image 10 of the surface S offers the possibility to identify, through such interface 5, the area affected by the pathology which is visually distinguished from the healthy part and will result from visual examination.
  • Such exam can be assisted by graphic instruments on the digital image 10, in order to improve the contrast and so on.
  • a particular lighting system for example inside a peculiar spectrographic range, can be useful to enhance the area target T to be treated.
  • this phase could effectively constitute a diagnostic activity, preliminary to the following operation, or it could follow a diagnostic activity previously carried out.
  • the operator can define the single area or the multiple target areas T, to be treated. To this or these areas it will be unambiguously associated a set of pixels, making the area target T recognizable in the subsequent phases.
  • Such definition could be done with the support of a set of parameters (spectral signatures) , purposely stored in the system memory. This phase could therefore be reduced to an automatic operation in which the image, acquired previously to the treatment is split into elementary areas, corresponding to a specific treatment needed, or to a predetermined pathology.
  • the acquired image elementary areas which correspond to a determined sample image of elementary area, can be incorporated in the list of the target areas T. Treatment points identification Such target area T will have greater or equal dimensions than the elementary area, which the punctual treatment assures on.
  • the elementary area is constituted by the spot of the laser itself, where the maximum of its energy is concentrated.
  • the image 10 acquisition resolution - representing the surface to be treated - must be appropriate so that the treatment area should be constituted by more pixels than the pixels that constitute the elementary area. In particular, it is a defined set of pixels which are defined in function of the spatial dimension of the spot for each treatment .
  • This phase can be manually managed by the operator or automatically, by setting up a closed polygonal, within which a regular mesh of points will be defined in such a way to cover the area target T.
  • the elementary area corresponding to the punctual treatment, to the spot of the laser, could coincide with the elementary area employed in the phase of identification of the area target T.
  • the surface S to be treated has a non modelable geometry and a set of reference points has to be identified.
  • the method according to the invention requires that one or more counterpart - repere - points should be identified on the surface S, or on its digital image 10, each of them being constituted from an area defined unambiguously from the pixels contained in it.
  • the counterpart - repere -points will be chosen in correspondence of characteristic points of the surface S, unambiguously determinable.
  • the visible venous ramifications will be selected.
  • the system pilot light is projected on the surface S to be treated, through the fixed visualization area F.
  • the pilot light indicates the elementary area on which the punctual treatment will act and constitutes its pointing system. Notice that such visualization area comprises the aforesaid target area and some of the aforesaid counterpart -repere- points R, no matter the surface accidental movements.
  • the pilot light is visible through the digital images acquisition system 3 and can be deflected to be overlapped to the treatment points that cover the target area T.
  • This operation is obtained for every image by continuously calculating the shifting vector between the pilot light and the chosen treatment point and using the information obtained by the counterpart - repere - points R current position recognition, at least for those that, time by time, are visible through such visualization area.
  • the closest to the treatment point will be privileged.
  • the computation can be realized on more repere points R, in order to assure a greater precision and a results crossed control .
  • the pilot light is moved from its initial position towards and along the distance defined by the vector.
  • the overlapping is not obtained on the first step, but it is necessary to iterate the process until such overlapping between pilot light and point of treatment is reached. This is possible because the images acquisition frequency and the vector computation speed is greater than the natural frequency that represents the surface accidental movements. Treatment and results examination. Once the overlapping is obtained, according to the invention, the condition that causes the treatment performance is verified.
  • the system allows the power laser to shot one or more impulses to photocoagulate the treatment point. As we said before, such point is unambiguously defined by a set of points. Such counterpart - repere - points are recognized on every surface S image continuous acquisition. The localization will be guaranteed during treatment, even if its physical characteristics could vary (enlargements, shifting and rotation movements are taken into account) .
  • the position of such elementary area can be identified, as such area will be marked by means of a specific graphical symbol on the image. Therefore, it is possible to visually examine the treatment effect through the pixel value variation caused by the treatment itself.
  • the pixel value variation is an objective parameter of the treatment outcome. Alternatively, it indicates the residual gap between the objective parameter and the obtained variation.
  • predetermined reference values can be used.
  • the subsequent treatment point of will be taken in exam and so on, as far as the complete target area coverage has been reached. Otherwise, the treatment point tracking will be repeated until the overlapping is reached and the treatment is performed. Then, a new comparison follows and in case of positive result, the subsequent point is taken in exam.
  • the target is reached with an iterative technique, based on the computation of the relative position between the target and the pilot light image.
  • the treatment activation is subordinated to the overlapping between pilot light and target. Therefore, treatments in areas not requiring it, independently from the manual abilities and operator assessment, are excluded.
  • Such overlapping is independent from an absolute coordinates system, and is obtained with an iterative and not predictive method, which is based, for every image, on the path minimization between the target and the pilot light.
  • the same device can be used to realize a feedback mechanism for outcome control. It is moreover agreed that, thanks to this retroactive analysis, it is possible to modulate in real time the punctual treatment intensity, redefining, if necessary, the treatment parameters.
  • the outcome of the ongoing treatment in relation to the predefined objectives can therefore be analyzed in terms of performance effectiveness, rapidity and flexibility. This is done, at every scanning, with a comparison of those parameters that reveal the treatment surface response, allowing therefore to determine the subsequent operation strategy.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Ophthalmology & Optometry (AREA)
  • Engineering & Computer Science (AREA)
  • Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Public Health (AREA)
  • Animal Behavior & Ethology (AREA)
  • Vascular Medicine (AREA)
  • Optics & Photonics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Human Computer Interaction (AREA)
  • Biophysics (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Image Processing (AREA)
  • Laser Surgery Devices (AREA)

Abstract

La présente invention concerne un procédé et un dispositif pour le traitement local d'une surface irrégulière (S), non métrique et soumise à des mouvements accidentels, qui permet d'effectuer un traitement ponctuel et pratiquement automatique et comprend les phases consistant à : faire l'acquisition d'une image numérique en temps réel (10) de la surface (S), la diviser en un ensemble de cellules élémentaires ou de pixels selon une résolution prédéterminée et associer à chaque pixel une valeur de référence ; identifier sans ambiguïté la zone cible (T) à traiter et un ou plusieurs points de repère (R), en associant un ensemble défini de pixels ; prédisposer une lampe témoin ; calculer le vecteur de déplacement entre la lampe témoin et les points de traitement, en utilisant comme système de référence les points de repère (R) qui sont visibles à travers une zone de visualisation (F), et déplacer la lampe témoin selon le vecteur de déplacement, en itérant le processus jusqu'à ce que la superposition entre la lampe témoin et le point de traitement soit obtenue ; appliquer le traitement ponctuel sur le point de traitement ; et répéter les phases précédentes pour chaque point de traitement jusqu'à ce que la zone cible (T) tout entière ait été traitée ; et chaque cible jusqu'à ce que le résultat voulu soit atteint.
PCT/IB2006/051047 2006-04-05 2006-04-05 Procede et dispositif pour le traitement au laser local d'une surface irreguliere WO2007113623A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/IB2006/051047 WO2007113623A1 (fr) 2006-04-05 2006-04-05 Procede et dispositif pour le traitement au laser local d'une surface irreguliere

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/IB2006/051047 WO2007113623A1 (fr) 2006-04-05 2006-04-05 Procede et dispositif pour le traitement au laser local d'une surface irreguliere

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0391376A1 (fr) * 1989-04-06 1990-10-10 Nissim Nejat Danon Dispositif pour chirurgie à laser informatisée
US5620436A (en) * 1994-09-22 1997-04-15 Chiron Technolas Gmbh Ophthalmologische Systeme Method and apparatus for providing precise location of points on the eye
US6210401B1 (en) * 1991-08-02 2001-04-03 Shui T. Lai Method of, and apparatus for, surgery of the cornea
WO2001028476A1 (fr) * 1999-10-21 2001-04-26 Technolas Gmbh Ophthalmologische Systeme Reconnaissance et suivi de l'iris en vue d'un traitement optique

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0391376A1 (fr) * 1989-04-06 1990-10-10 Nissim Nejat Danon Dispositif pour chirurgie à laser informatisée
US6210401B1 (en) * 1991-08-02 2001-04-03 Shui T. Lai Method of, and apparatus for, surgery of the cornea
US5620436A (en) * 1994-09-22 1997-04-15 Chiron Technolas Gmbh Ophthalmologische Systeme Method and apparatus for providing precise location of points on the eye
WO2001028476A1 (fr) * 1999-10-21 2001-04-26 Technolas Gmbh Ophthalmologische Systeme Reconnaissance et suivi de l'iris en vue d'un traitement optique

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